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Request Homeowners Insurance Quote

For the fastest and most accurate insurance quote, please provide as much information possible in the form below. This information will be kept confidential and will be used for quote purposes only.

Please note that no coverages can be changed, altered or bound through this form.

General Information
Name:
Address:
City:

 
State:
Zip:
County:
Email:
Phone Day:

 
Phone Night:
Best time to call:
AM   PM  

Current Homeowner's Insurance Company (not agency)
Company Name:
Policy Exp. Date:

 
Dwelling Insured For:
Personal Property:
Liability Limit:
Premium:
Deductible:

 

 

Home Information
How long at present address:
years   months
 
Type of Home: Single Family 2 Family  Other
Number of claims in last 3 years:
Total Sq. footage of home
(excluding garage and basement):

Year home was built:

 

Structure Information
Type:

 
Construction:
Roof:
Foundation:

 
Garage:
    Age of Roof:
yrs.
 
Your Estimate of Construction Quality:
Economy   Average    Custom    Architect Unique

Features
Bathrooms:
# of Full:
# of Half:
 
Basement:

Sq. Ft:
 
Deck/Porch/Patio:
Deck Sq. Ft:                
Porch Sq. Ft:               
Screen Patio Sq Ft:   
Fireplaces:
# Chimneys:
# Hearths:    
Heating System:
Central Air:
Yes   No
Central Vac:
Yes   No
Smoke Detector:
Yes   No
 
Security Alarm:

 
Fire Alarm:
   

Other Insurance Information & Coverage Considerations
Distance to Nearest Fire Hydrant:
Under 1000 Feet
Over 1000 Feet
 
Distance to Nearest Fire Department:
Under 5 Miles
Over 5 Miles
Occupancy:
Owner Occupied
Tenant Occupied
 

Additional Comments

Please give any additional comments about the coverage you desire:

 

 


 

Kleeber Insurance Services, established in 1851, is a subsidiary of Kinderhook Bank Corporation, the holding company for Kinderhook Bank.

*Insurance products are not a deposit or an obligation of, or guaranteed by, Kinderhook Bank. Not FDIC insured.